Haematuria

Question 1

What are the causes of transient or spurious non-visible (microscopic) haematuria?

Answer 1

urinary tract infection
menstruation
vigorous exercise (this normally settles after around 3 days)
sexual intercourse

Question 2

What are the causes of persistent non-visible haematuria?

Answer 2

cancer (bladder, renal, prostate)
    stones
    benign prostatic hyperplasia
    prostatitis
    urethritis e.g. Chlamydia
    renal causes: IgA nephropathy, thin basement membrane disease

Question 3

What are the spurious causes of haematuria?

Answer 3

red/orange urine, where blood is not present on dipstick

foods: beetroot, rhubarb
drugs: rifampicin, doxorubicin

Question 4

How is haematuria tested?

Answer 4

urine dipstick is the test of choice for detecting haematuria
persistent non-visible haematuria is often defined as blood being present in 2 out of 3 samples tested 2-3 weeks apart
renal function, albumin:creatinine (ACR) or protein:creatinine ratio (PCR) and blood pressure should also be checked
urine microscopy may be used but time to analysis significantly affects the number of red blood cells detected

Question 5

What heralds an urgent referral for haematuria?

Answer 5

Aged >= 45 years AND:
unexplained visible haematuria without urinary tract infection, or
visible haematuria that persists or recurs after successful treatment of urinary tract infection

Aged >= 60 years AND have unexplained nonvisible haematuria and either dysuria or a raised white cell count on a blood test

Question 6

What heralds a non-urgent referral for haematuria?

Answer 6

Aged 60 >= 60 years with recurrent or persistent unexplained urinary tract infection

Since the investigation (or not) of non-visible haematuria is such as a common dilemma a number of guidelines have been published. They generally agree with NICE guidance, of note:

patients under the age of 40 years with normal renal function, no proteinuria and who are normotensive do not need to be referred and may be managed in primary care